Scrivener's palsy

Writer ailments

Anonymous asked me to talk about Repetitive Strain Injury this week, so as usual I'm using it as a prompt to expand on a wider topic: writer ailments. 

Writers, alas, are notoriously unwell people. It seems to be a side-effect of the art. A recent book by John Ross, Orwell's Cough: Diagnosing the Medical Maladies & Last Gasps of the Great Writers (cheerful stuff), is dedicated to studying the various conditions from which our literary ancestors suffered. I'm not going to talk about mental illness today, because it's such a vast topic that it merits its own entry. Instead I'm going to shed some light on some of the physical conditions writers suffer when they push their bodies too far, and how those conditions work. Why does coffee wake us up, and why do we get addicted to it? 

I've suffered, or suffer from, most of these conditions. I had them particularly badly when I was working on Aurora, when I was working for up to fifteen hours a day and generally turned myself into a wreck of a human being. I tried to be better behaved with The Bone Season, but I still get the odd problem. Remember, I'm not a GP, and this entry will only give a rough overview of each condition. If you think you might have any of these, do get it checked out with a medical professional.   


Back pain 

Back pain comes in many forms, and produces many degrees of pain, but it's always unpleasant. It's often caused by bad posture. Writers can be hunched over computers or manuscripts for hours or even days at a time, which does your back no favours. 

Ideally, you should be sitting at your desk with the top of the screen at eye level, your back straight, elbows close to your body, shoulders relaxed, feet resting flat on the ground (or on a footrest). The screen should be roughly an arm's length from your eyes. This all sounds like a lot to remember, but you'll naturally develop good posture if you set up your workspace properly.    

Make sure your workspace is equipped with an adjustable chair that supports your back. If it doesn't, you can buy a separate orthopaedic back cushion. I use the Houston High-Back Leather-faced Executive Chair and the Fellowes Portable Lumbar Support, both from Staples. You might have to shell out for a decent office chair, but it's better than suffering in silence on a cheap one, and it will last you a long time. It's an investment. There are also heated back supports available if you want to be really decadent. Scroll down to RSI to learn more about proper wrist posture. 

William Alexander
Literary sufferers: Most writers will have experienced back pain in one form or another, but here's some examples of literary back woes. Roald Dahl had back pain for which he had to undergo surgery. William Alexander, winner of the 2012 National Book Award for Goblin Secrets, has to write standing up due to a spinal defect. He works at an espresso bar in a coffee shop in Minneapolis, which he calls his "steampunk desk" – it's made of copper pipe, antique glass doorknobs and tooled stainless steel. He said to me that "sitting is bad for everyone! Just extra bad for me." Take heed. Another writer unable to sit down, though not due to a spinal injury, was Ernest Hemingway, who wrote standing up after a leg injury gained during the war. Thanks to my Twitter followers DWD Johnson and Kirstin Corcoran for letting me know about these! 

Caffeine addiction 

Like ink, wine and the sweat of our labour, coffee is one of the fuels that keep us writers going. Legend erroneously tells that when drunk monk Dom Pérignon first tasted champagne, he cried "Come quickly, I am drinking the stars!" That's pretty much what happened to me when I took my first sip of coffee. Suddenly I could get through hours and hours of writing without face-planting the keyboard halfway through a scene. Writing and coffee go hand in hand. Not all of us work well by day, and we need something to keep us bright and breezy as we work towards our dreaded deadlines.

So why does caffeine wake us up? Turns out it's a bit of a trickster: it fools the body into thinking it's a neurotransmitter called adenosine. Adenosine causes drowsiness by binding to receptors in the brain, which slows down nerve activity. Caffeine resembles adenosine and binds to adenosine receptors, but unlike adenosine, it doesn't slow down nerve activity - instead, it speeds everything up. Because the caffeine is taking up all the nerve receptors, the effects of adenosine are blocked, and you don't get drowsy. It increases neuron firing, confusing the pituary gland, which think there's an emergency and starts to pump out adrenaline. It also messes around with dopamine, the neurotransmitter that activates pleasure in the brain. 

The three big effects of caffeine – blocking drowsiness, stimulating adrenaline and making you feel goodgive your body and mind a short-term boost. French writer Balzac compared it to "sparks shoot(ing) up to the brain". It's easy to see why we keep drinking it. But if you drag yourself out of bed without a cup of joe, chances are you're becoming dependent on it. It puts your body into a state of emergency, making you irritable and twitchy, and if drunk at the wrong time, it can cause a ruthless cycle of insomnia. 

When you make coffee, keep in mind that the half-life of caffeine in the body is about six hours. If possible, only drink it in the morning. 

Honoré de Balzac
Literary sufferers: You may think you have a coffee problem, but Honoré de Balzac would beg to differ. An obsessive worker, Balzac would drink up to fifty cups of thick black coffee a day to fuel his hours of writing. If he couldn't wait for his brew, he'd chew a handful of coffee beans. He suffered from some major health problems, including sky-high blood pressure, stomach pains and hypertrophy in the left venticle of his heart. He died at 51. Check out his essay, 'The Pleasures and Pains of Coffee'. Max Wallis, author of Modern Love (shortlisted for the 2012 Polari First Book Prize), told me that as a student he would get through three bicafetières per day, only sleeping between 3 and 6am. Jonathan Swift and John van Druten were also quoted on their love for caffeine. (Van Druten said "I think if I were a woman I'd wear coffee as a perfume".)

Eye strain

Properly called asthenopia, eye strain comes from staring at something up close for a long, long time – in a writer's case, that's usually a manuscript. It's caused by the ciliary muscle at the front of the eyeball, which contracts when you're relying heavily on your eyes to complete a task. This causes your eye to become irritated. You might get blurred or double vision, red or dry eyes, or a headache. Eye strain doesn't generally cause lasting damage to your eyes, but it causes an annoying, dull pain and can inhibit concentration. 

The best way to avoid eye strain is by giving yourself regular breaks from the computer screen and focusing on a distant object. I try to take a break from writing at least once an hour and go for a walk, or look out of the window. Eye drops help, too. Make sure you work in a well-lit room. If you wear glasses, you can pay a small amount of money to get an anti-reflective coating on the lenses (suggested by Mohsin). This helps reduce glare and allows you to work for longer without straining your ciliary muscle. Lenses with this coating will have a slight blue-green tint to the light reflections on their surface.

A great piece of software, recommended by virtuefiction, is f.lux. I just downloaded it and it's brilliant. The light emitted by your computer screen is designed to resemble sunlight, which is great in the day but at night, the harsh, bluish glow can strain your eyes and keep you awake, as your body thinks it's still daytime. If you get f.lux and give it access to your location, it detects the time of day and after sunset, it will give the screen a warm, orangey tone, like indoor lights. 

Literary sufferers: I haven't found any specifics for eye strain – I think we can safely assume that most writers have had it – but there are lots of cases of eye problems among the literati: Aldous Huxley (visited the therapist William Horatio Bates after an attack of keratitis and later wrote the book The Art of Seeing detailing his experiences), Emily Dickinson (suffered from an unknown eye affliction – possibly uveitis – that caused sensitivity to light, beginning in autumn 1863, for which she received treatment from Boston opthalmologist Henry Willard Williams) and James Joyce (plagued by eye problems throughout his life, including uveitis, glaucoma, cataracts and conjunctivitis) among them.   


Migraines are my blessing and my curse. I really ought to thank them, because they gave me the idea for clairvoyants to be identifiable by their aura in The Bone Season. I first started getting them in 2009, during my A-Levels. The first time I had one, I staggered to the optician and begged them to stop me going blind. As it turned out, I was experiencing a sensation called scintillating scotoma, which is basically a big, glimmering, multicoloured obstruction in your vision. (The picture in the left is an artist's impression of a scintillating scotoma by Tama Blough.) Scotoma can manifest in a variety of different ways – partial loss of vision, for example – but for me, it's like a kaleidoscopic firework show bursting in the front of my eye. I drew heavily on my experiences with migraine to invent the visual aspects of The Bone Season, including aura and the spirit sight. So thanks, migraines. 

Migraine comes from the Greek word ἡμικρανία, roughly translated as "half-skull", referring to the tendency of migraine to affect only one side of the head. It
's thought to be caused by chemical imbalances in the brain, specifically low levels of serotonin. When serotonin levels drop, the blood vessels in the brain spasm and contract. This is the phase of migraine that causes aura in some migraineurs. This contraction is followed by sudden enlargement of the blood vessels, which causes the pain. There are also various environmental, dietary, physical and emotional factors that can trigger a migraine. Bright lights often get me. When I get a migraine, it feels like the front of my skull is several sizes two small. You might also experience a sensitivity to light, nausea and vomiting. 

There are a number of treatments for migraine. I take a drug called sumatriptan, which stimulates the production of serotonin. You can either take the pills when the migraine starts, like I do, or take pills regularly to prevent migraines coming. I often find myself getting one when I write. I always know when it's coming, because I'll be working on a chapter and suddenly won't be able to see whole sentences – letters will suddenly go missing, sucked into the little blind spot that will grow into a scotoma.
Miguel de Cervantes

Literary sufferers: Creative types are apparently more likely to get migraines. Literary migraineurs of the past include Emily Dickinson (sometimes assumed from her 1863 poem 'I felt a Funeral, in my Brain'), Miguel de Cervantes, Virginia WoolfRudyard Kipling ("One half of my head, from the top of my skull to the cleft of my jaw, hammers, bangs, sizzles and swears"), Lewis Carroll and Charles Darwin (he called migraine his "hereditary weakness", and was unable to attend his father's funeral because of it). 

Repetitive Strain Injury (RSI)

Often linked to writing, RSI does what it says on the tin. It's a musculoskeletal condition caused by repetitive tasks like typing, lifting, or using a phone keypad – tasks which involve you overusing certain muscles and tendons. I get bouts of RSI when I work on a manuscript for hours at a time over the course of several weeks. 

RSI is easy to prevent. You'll feel it coming: stiffness in your fingers, sore wrists, painful muscles and joints in your arms. Part of prevention is ensuring you have good posture when you write. Ideally, your wrists should not be bent in order for your fingers to reach the keys. You can buy a wrist rest, usually soft or filled with gel, to keep them in a neutral position. This is placed in front of the keyboard. I use the Fellowes Crystal Keyboard Wrist Rest from Staples.  

The most important thing to do is to take regular breaks. Still, if you write a lot, especially to tight deadlines, it's worth buying yourself a little anti-RSI kit. Be sure to include wrist braces for when your wrists get painful. I use the cheap 'n' cheerful Elastoplast Sport adjustable supports from Boots, but there are lots of different kinds, each providing different levels of support. Another handy remedy is cod liver oil. It's often used to ease the joint pain associated with arthritis, but it can also help with RSI. You can take it in liquid form, but it tastes as rank as it sounds. I use the Seven Seas brand and take it as a capsule, one every day. Just don't bite the capsules, no matter how much like bottled sunlight they look. You can also try soaking your hands in Radox and warm water. 

Related conditions

Two conditions thought to have similar causes to RSI are focal dystonia and carpal tunnel syndrome. FD, also called writer's cramp, can lead to loss of fine motor control in the hands, curled or stretched fingers, and a myriad of other symptoms that can interfere with writing. Treatment will vary, depending on what caused it. 
CTS is caused by pressure on the median nerve, which gives feeling to the side of your hand your thumb is on. This can cause numbness, tingling and pain in the affected hand and wrist. 
Albert Schweitzer

Literary sufferers: Franco-German philosopher, theologian and organist Albert Schweitzer. Schweitzer is thought to have suffered from focal hand dystonia, though he was never formally diagnosed. He used special pens to combat the condition. The cramps in his arm were triggered by handwriting, meaning he struggled to form coherent letters – but it didn't affect his famous organ-playing.

Do you suffer from an ailment related to writing? How do you cope with it? Has it helped or inspired you in any way, like my migraines?


  1. Hi congratulations on the book deal been reading your blogs for a while now. I find them really useful, and think you're writing style is amazing (I read the sample of The Bone Season on Facebook.)
    I really am excited about your novel coming out in August. You're worth the wait and all the advice you have given has been very useful. Thanks!

    Quick question. Did you see many similarities between your novel and others? And if you did, did it put you off from putting the idea or scene in the final version of your book?

    1. Hi Aleem – thanks for reading! So glad you enjoyed the Facebook sample and that you're finding the advice useful.

      Hm. I suppose I saw similarities to other books in the dystopian aspect of The Bone Season, as there are quite a lot of dystopian novels out at the moment – I was inspired by Orwell, Atwood and Wyndham – but that didn't put me off writing it. I tried to distinguish it from other fantasy and dystopian novels I'd read, and to write as much outside genre as possible. I wasn't put off writing any ideas or scenes, no.

    2. Thanks for replying. Was wondering if you could write a blog post on plotting in general (not sure if you've already done this.)
      I'm struggling with my writing at the moment. :(
      Starting to think of letting go and working on some fresh material.

      P.S Ive told quite a few people about your novel - shows them that you can get published at a young age!

    3. I've mentioned my planning process in quite a few posts, including this one: If you'd still like some more advice, could you ask some specific questions about plotting? Otherwise I run the risk of repeating myself.

      And thank you for spreading the word!

    4. Ok will have a look at the post.
      Basically, I often get carried away with plotting and don't know when to stop. Did you have this problem? And if so do you know any way I can know for sure when the plot is sufficiently detailed and ready to start turning into a novel.
      Oh and whats your biggest tip for writing a publishable novel.

      Sorry for all the questions, just thought I'll make the most of this blog before probably half the world discovers it making contact for advice and help from you virtually impossible!

    5. I think you need to have some idea of where you're going with the plot, i.e. the beginning, most of the key events and the ending. There's no sure-fire way to know for certain when you're ready to turn your planning into a novel. I tend to describe it as a skeleton-and-flesh model: you need to know the bare bones of the story, but you can flesh it out as you go along. If you over-plan you'll never start. Often it's helpful to actually put your character in the world and start writing, and the plot will just come together naturally. It depends on the kind of writer you are.

      My biggest tip... I'd say "find your voice". The writer's voice is incredibly important to both agents and publishers, and you might need to experiment for a while before you find it. I had to write a whole novel in third-person to realise it wasn't working out. After I tried first-person, I started enjoying myself a lot more and the writing just flowed through my narrator. If you don't enjoy writing something, it's unlikely that people will enjoy reading it.

  2. Thanks for posting this..I haven't suffered any of them though..
    Unluckily I have a weak eyesight, that's another story.
    I wanted to ask when you got agent and publisher, and you told your parents, how did they took it the news?
    Of course they would have been happy and proud, but did they allowed it easily as you are still doing colllege? Did you have a discussion about it or what? Hope you understood my question and would answer it...
    I really want to know, it'd be helpful, thank you..

    1. My parents were thrilled for me. They were a little concerned about me still being at university, and we discussed whether or not I should take a year out to work on my editing and so on, but in the end I decided to carry on without a break. I've just had to manage my time carefully.

  3. You've been through the wars! I love that you've managed to make lemonade from a migraine :O). Thanks for all the great tips!

  4. Great in-depth article! I believe it was Orwell's Cough (Diagnosing the Medical Maladies & Last Gasps of the Great Writers) by John Ross, not an article (your link is a review of the book). The book also explores the likelihood that Shakespeare had syphilis, to name one of the "maladies".

    I bought prescription glasses last year for use on computer and reading. Also, if you've yet to try it, there is a really amazing freeware called (and you'll love this, Samantha) "f.lux" which reduces the blue that light your computer emits, essentially adjusting your computer's display settings throughout the day. It sounds a bit of a gimmick, but it is truly worth trying out if you're a writer (I'd not recommend it so much for people that edit graphics, etc.). Like many converts, I can't imagine working on my WiP without it. You can check it out here:

    1. Thanks, I'll correct that.

      I love the sound of f.lux! I just downloaded it. Waiting for sunset so I can see the effects. I'll add it to the section on eye strain. Thanks so much for the recommendation!

  5. It is interesting to know that you got ideas for clairvoyants from the Migraine pain!. It is more than just a headache, really bad headache. For working on computer, it is best to choose anti-reflective coating eyeglasses that will minimize glare of screen and eye-strain. Also, you should use larger font size while working, they are good for eyes.Lighting is also very important factor.

    For RSI and related conditions, as you said, regular breaks are necessary to prevent more damage.

    1. Thanks Mohsin, I'll add your suggestion about the anti-reflective glasses. And yes, migraine can cause terrible pain – my mum went through a period of having such bad migraines that we had to send her to hospital whenever she got one.


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